Clinical and angiographic findings in black patients with suspected coronary artery disease.

To determine the clinical variables and coronary angiographic findings in black patients with suspected coronary artery disease, we analyzed the data on consecutive black patients undergoing their first coronary angiogram over a three year period at the Cook County Hospital, Chicago, Illinois. We compared these findings to those of black and white patients from previous studies. There were 654 patients with a mean age+/-standard deviation of 56+/-10 years; 309 (47%) were men. Two hundred nineteen patients (33%) presented with unstable angina, 75 patients (12%) with acute myocardial infarction and 338 patients (52%) with chronic stable angina. Three hundred forty-six patients (53%) had 50% or greater stenosis in at least one of the major vessels. Among the patients with coronary artery disease, 128 patients (37%) had one vessel disease, 102 patients (29%) had two-vessel disease, and 116 patients (34%) had three-vessel disease. Black patients who undergo coronary angiography for suspected coronary artery disease have a high frequency of normal coronary angiogram or non-obstructive coronary artery disease. The frequency of 1-, 2- and 3-vessel disease in blacks with coronary artery disease is comparable to those observed in whites in previous reports.

Etiology and characteristics of congestive heart failure in blacks.

In this study of 301 black patients with congestive heart failure (CHF), systemic hypertension is the most common cause of CHF and is the primary etiology of CHF in 61%. Left ventricular hypertrophy is highly prevalent and is seen in 63% of the patients who had an echocardiogram.

Results of surgical treatment for infective endocarditis in intravenous drug users.

OBJECTIVE: To determine the early and late results of surgical treatment for infective endocarditis (IE) in intravenous drug users (IVDU). DESIGN: Cohort study of consecutive IVDUs undergoing surgical treatment for IE. SETTING: Large public hospital serving the urban population of Chicago, Ill. PATIENTS: Consecutive IVDUs operated on between July 1982 and June 1991 for IE. MAIN OUTCOME MEASURES: Death, stroke, noncerebral systemic embolization, major bleeding, recurrent endocarditis, and repeated valve replacement. RESULTS: There were 80 patients, 58 men and 22 women, with a mean age of 37.5 +/- 10 (SD) years. The hospital course in all patients and follow-up data on 75 (94%) patients were complete. The primary indication for surgery was acute congestive heart failure in 44 (56%), persistent sepsis in 21 (26%), and multiple systemic embolization in 15 (19%) patients. Six patients (7.5%) died within 30 days of surgery. An additional 13 of 69 patients (17.6%) died during the follow-up, 8 from cardiovascular causes. The probability of survival at 36 months and at 60 months was 0.74 +/- 0.05 (SE) and 0.70 +/- 0.05, respectively. Seventeen (30%) of the survivors had at least one major cardiovascular event; 6 (8.8%) had recurrent endocarditis, 4 (5.8%) had stroke, 3 (4.4%) had extracerebral bleeding, 1 had extracerebral systemic embolism, and 3 (4.4%) required repeated valve replacement. Probability of event-free survival at 36 months and 60 months was 0.65 +/- 0.06 and 0.52 +/- 0.08, respectively. The median duration of event-free survival was 65 months. CONCLUSION: Since the expected mortality without surgery in patients with IE in whom medical treatment fails is almost 100%, it is concluded that surgical treatment is indicated for, and substantially improves the outlook for early and late survival of, IVDUs with IE who fail to respond to medical management.